Filetype PDF | Posted on 04 Jan 2023 | 2 years ago
Authentication
digital resources
139x Filetype PDF File size 0.39 MB Source: biomedres.us
DOI: 10.26717/BJSTR.2018.05.001197
Aisha Iftikhar. Biomed J Sci & Tech Res ISSN: 2574-1241
Research Article Open Access
Maternal Anemia and its Impact on Nutritional
Status of Children Under the Age of Two Years
1 2 3 4 5
Aisha Iftikhar* , Attia Bari , Fatima Zeeshan , Uzma Jabeen , Qaisar Masood and Ahsan Waheed
6
Rathore
1-4,6Department of Pediatric Medicine, The Children’s Hospital and The Institute of Child Health, Pakistan
5Consultant Pediatrician, Nawaz Sharif Social Security Hospital, Pakistan
Received: May 28, 2018; Published: June 11, 2018
*Corresponding author: Aisha Iftikhar, 342 Kareem Block, Allama Iqbal Town Lahore, Pakistan
Abstract
Objective: To assess the frequency of anemia in mothers accompanying children admitted in General Medical Ward of The Children’s
Hospital Lahore and to determine its association with the growth parameters of their children under two years of age.
Methodology: Total 228 children admitted in General Medical Ward with acute illness along with their mothers were included in the
study. Blood sample of their mothers for Hb level was taken. Height and weight of children were plotted on WHO Growth Charts. Anemia was
defined according to World Health Organization (WHO) as hemoglobin level of <12 g/dL in non-pregnant women. Data was analyzed using
SPSS version 20.
Results: Out of 228 patients 147 (64.5%) were males. The mean age of children was 8.7 ± 6.6 months. Mean maternal age was 26 ± 5.3
years. Anemia was present in 154 (67.5 %) mothers. Mean maternal Hb was 10.6 ± 1.6 gm/dl. Forty-nine percent children were severely
underweight (Z score <-3) and 37 (16.2%) were falling on median. Severely stunted children were 92 (40.4%) (Z score <-3) while 43 (18.9%)
were at median. Low weight for age and Length/Height for age of children was significantly associated with maternal anemia (p= 0.017),
(p=0.05) respectively. Other maternal factors affecting the child’s nutritional status and growth parameters were multi-parity, general maternal
health and education level with p value of 0.005, 0.01 and 0.04 respectively.
Conclusion: Maternal anemia has a significant effect on nutritional status of young children leading to stunting and underweight.
Associated maternal factors were maternal education, multi-parity and poor maternal health.
Keywords: Maternal anemia; Stunted children; Underweight children
Introduction
Developing countries are bearing huge burden of anemia and Anemic mothers have significant diminution in working capacity
it is persisting as a public health issue worldwide [1]. Women of causing difficulties in performing house hold chores and child care,
child bearing age, pregnant women and children are considered thus affecting growth para meters of children of anemic mothers
as high risk population group [2]. In Pakistan 52% of pregnant [11]. So, the hazardous effects of anemia in pregnancy on infant’s
women 32% of women of childbearing age are victims of anemia growth multiply and intensify when anemic mothers cannot give
[3]. Worldwide more than 50% pregnant women and 30% of all proper attention and care due to their own ill health. With each
women of childbearing age suffer from anemia [4]. In developing pregnancy, this problem magnifies and in next pregnancy and
world although iron deficiency accounts for half of cases but other lactation phase she suffers iron deficiency because of inadequate
nutrient deficiencies like (vitamin A, riboflavin, folic acid, and pre-pregnancy iron reserves. Thus, anemia is a life-long burden
vitamin B12), parasitic and infectious diseases also play significant for women one which also endangers their children’s growth
role[5,6]. Consequences of anemia are diverse [7]. In pregnancy, parameters and nutritional status [12]. Most of our mothers are
detrimental effects associated with anemia lead to low birth suffering from the adverse effects of anemia. This aspect of maternal
weight babies [8] and pre-term deliveries [9]. Substantial number health is being ignored. Previous studies have elucidated risk
of cases of anemia in infancy and childhood are due to maternal factors for child under nutrition like maternal behaviors, dietary
iron deficiency. Anemia causes impaired physical growth of infants, factors and environmental factors etc [13]; but research on this
preschool and school aged children [10]. neglected factor like maternal anemia, which might also predispose
a child to increased risk of growth impairment is lacking.
Cite this article: Aisha I, Attia B, Fatima Z, Uzma J, Qaisar M, et al. Maternal Anemia and its Impact on Nutritional Status of Children Under 4519
the Age of Two Years. Biomed J Sci &Tech Res 5(3)- 2018. BJSTR.MS.ID.001197. DOI: 10.26717/ BJSTR.2018.05.001197.
Aisha Iftikhar. Biomed J Sci & Tech Res Volume 5- Issue 3: 2018
We conducted our research on children from 2 months to two children under five and Hb level was presented as mean and SD.
years as maternal factors have an immediate effect on a child’s life Variables like maternal education level and father’s education level
during this period of enormous growth. Through this study we was presented by calculating frequency and percentages. Chi square
planned to document in literature that maternal anemia can be a test was applied and p value <0.05 was considered significant.
risk factor in growth parameter impairment of their children even Results
up to age of infancy and beyond. A total of 228 patients were included in this study. Males 147
Methodology (64.5%) out-numbered the females 81 (35.5%), with a male to
This was a hospital based descriptive cross-sectional study, female ratio of 2:1. The mean age of children was 8.7± 6.6 months.
conducted at The Children’s Hospital and The Institute of Child The range of maternal age was 18 to 43 years with mean age of
Health (ICH) Lahore. Approval from Institutional Review Board 26.8±5.302 years (Table 1). Out of 228 mothers 79 (34.6%) were
of The ICH was taken. Children from aged two months to two of less than 25 years and 149 (65.4%) were between 25-45years.
years admitted to General Medical Ward of for any acute illness Only 74 (32.4%) mothers had hemoglobin level at or above 12 gm/
like pneumonia, acute diarrhea, febrile fits were included in the dl and 154 (67.5 %) were anemic. (Figure 1) Mean maternal Hb
study along with accompanying mothers. Consent was taken from was 10.67 ± 1.6 with the range of 6-15 gm/dl. According to WHO Z
mothers before enrolling them in study. Children of < 2 months Scoring 112 (49.1%) children were severely underweight (Z score
and > 2 years and those having any chronic disease were excluded. <-3) and only 37 children (16.2%) were on median shown in Figure
Information about demographic profile, weight, height, health 2. Severely stunted children (< -3) were found to be 92 (40.4%) and
status, parity and mother’s education status were determined. No of 43(18.9%) were having appropriate height for age i.e. at median,
children and number of under five children were recorded. Father’s illustrated in Figure 3.
education status and monthly income was also inquired. Child’s
age, height or length (in less than 1year) and weight of the child
was documented and was plotted on WHO - Z Score Charts. Their
weight, height or length (in less than1year) was measured by our
appropriately trained doctor. 5 cc venous blood sample was taken
from mothers for complete blood count including hemoglobin, red
blood cells count and hematocrit.
After collection blood was immediately transferred into
labeled and prepared tubes containing EDTA or heparin and sent
to laboratory for hemoglobin estimation. Anemia was defined
according to World Health Organization (WHO) hemoglobin level
of <12 g/dL in non- pregnant adult woman [14]. The information
collected was analyzed by using statistical software SPSS -20. The Figure 1: Maternal Hemoglobin Levels.
quantitative variables like age, height, weight, family size, no of
Table 1: Maternal factors affecting weight of children.
Factors < 3 to -3 < - 2 to -2 < -1 to -1 Median or > Total P-value
Hb level Normal 39(34.8%) 13(36.1%) 18(41.9%) 4 (10.8 %) 74(32.5%) 0.017
Anaemic 73(s65%) 23 (63.9%) 25 (58.1%) 33 (89.2%) 154(67.5%)
General Good 19 (17%) 12 (33.3%) 14 (32.6%) 8 (21.6%) 53 (23.2%)
Maternal Average 85 (75.9%) 17 (47.2%) 27 (62.8%) 27(73.0%) 156(68.4%) 0.018
health Poor 8 (7.1%) 7(19.4%) 2 (4.7%) 2 (5.4%) 19(8.3%)
Upto 3 48 (42.9%) 26 (72.2%) 30 (69.8%) 26 (70.3%) 130(57.0 %)
Parity 5-Apr 42 (37.5%) 7 (19.4 %) 10 (23.3%) 7 (18.9%) 66(28.9%) 0.005
> 5 22 (19.6%) 3 (8.3 %) 3 (7.0 %) 4 (10.8%) 32
Illiterate 69 (61.6%) 20 (55.6%) 20 (46.5%) 19 (51.4%) 128 (56.1%)
Maternal Primary 23(20.5%) 6 (16.7%) 8 (18.6%) 14 (37.8%) 51 (22.4%)
education Secondary 15 (13.4%) 10 (27.8%) 13 (30.2%) 3 (8.1%) 41(18%) 0.04
Graduate 5(4.5%) 0 (0%) 2 (4.7%) 1 (2.7%) 8(3.5%)
49.10% 15.80% 18.90% 16.20% 100%
Biomedical Journal of 4520
Scientific & Technical Research (BJSTR)
Aisha Iftikhar. Biomed J Sci & Tech Res Volume 5- Issue 3: 2018
have shown the prevalence of anemia in women of reproductive age
group ranging from 16.6% to 30.4%, A study done in Abbottabad
(Pakistan) on prevalence of anemia in child bearing age women has
shown almost similar results as in our study i.e. 60% [17].
We found that 112 (49.1%) children were severely underweight
(Z score <-3) while 36 (15.8%) children had weight for age <-2
and 43(18.9 %) had weight for age (<-1 to < median) however 37
(16.2%) were on median and more than median. Almost similar
percentage of children i.e. (15.7%) have been shown in Child
Nutrition Status by Region, 2010 results for moderate malnutrition.
But percentage of children having severe malnutrition in our
study is quite high than shown in 2010 report. i.e. (49.1% in our
Figure 2: Pattern of Weight for Age of Children. study but 23.7% in 2010, 2011 survey) [18]. This difference may
be due to time elapsed between two studies secondly our data
was hospital based which may have increased proportion of
severely underweight children. This figure may raise the issue that
appropriate interventions to combat the problem of malnutrition in
Pakistan by the policy makers is not started yet which has resulted
in such a great difference.
In this particular study, we found severely stunted children (<
-3) to be 92 (40.4%) while 47 (20.6%) were moderately stunted
(<-2) and 46 (20.2%) falling at < -1. It was found that 43 (18.9%)
children were at median or above median. Almost similar results
were reported in NNS-2011 and Child Nutritional status 2010
about severely and moderately stunted children i.e. 43.7% and
Figure 3: Pattern of Height for Age of Children. 20.2% respectively [19]. We found significant association between
weight for age and height or length for age of the children with
We found significant association between weight for age and maternal Hb level. Effect of maternal anemia on growth of children
height or length for age of the children with maternal Hb level was also observed by Singla where effect on fetal growth was
with p value of (0.017), (p= 0.06) respectively. During the study, observed in all parameters [20]. Statistical significant association
other parameters were also studied like parity, number of under 5 was also found between maternal anemia and low birth weight
children, general maternal health, mother’s and father’s education babies by Ahmad [21]. This powerful association between weight
level and father’s income. It was not astonishing for us that for age and height and length for age of the children with maternal
parameters related to mothers like parity, general maternal health Hb level emphasizes that child wellbeing is intimately embedded
and mother education level had a significant effect on children’s with maternal serenity and contentment.
weight with p vale of 0.005, 0.01 and 0.04 respectively. During the study, other parameters were also studied like
Discussion parity, number of under 5 children, general maternal health,
We assessed the frequency of anemia in mothers of children mother’s and father’s education level and father’s income. It was
admitted in General Medical Ward of The Children’s Hospital and not astonishing for us that parameters related to mothers like
determined its association with the growth parameters of their parity, general maternal health and mother education level had
children.The demographic analysis shows a high proportion of a significant effect on children’s weight with p vale of 0.005, 0.01
patients having male gender i.e. 147 (64.5%), with a male to and 0.04 respectively. Various studies done in different parts of
female ratio of 2:1. This may signify the male dominance and sex world also endorse this fact for example a study done in Kenya has
discrimination in South East Asia. Male children are preferred in shown a strong positive and significant association with growth
all aspects and it is also true in medical aid seeking behavior. Boys parameters of children with parity of mother although in this
are brought to hospital more often than girls. A preponderance study other parameters like maternal education, mother marital
of males with 52.5% boys and 47.5% girls was noted in another status and maternal education level were also studied and found
study from Pakistan [15]. In our study, it was revealed that 154 these too are positively associated [22]. A Nigerian study has also
(67.5 %) mothers were anemic. These results are comparable to shown a strong association of maternal health with the growth para
an Indian study where Shoba Rao has documented seventy-seven meters of children [23]. A pooled analysis by O.Yaw Addo from 5
percent of the childbearing age women were anemic (Hb < 12 g/ birth cohorts (Brazil, Guatemala, India, the Philippines, and South
dl). This slight difference may be justified as this Indian study was Africa) has shown positive co-relation between maternal height
based on rural population [16]. Whereas several studies in Ethiopia and growth para meters of their children [24]. Similarly, OyaYucel,
Biomedical Journal of 4521
Scientific & Technical Research (BJSTR)
Aisha Iftikhar. Biomed J Sci & Tech Res Volume 5- Issue 3: 2018
Nursan Dede Cinar has validated in his attention-grabbing research 11. Kalaivani K (2009) Prevalence & consequences of anaemia in pregnancy.
that maternal body mass index which is the best indicator of health Indian J Med Res130(5): 627-633.
has direct impact on growth para meters of children [25]. 12. Terefe B, Birhanu A, Nigussie P, Tsegaye A (2015) Effect of Maternal Iron
Deficiency Anemia on the Iron Store of Newborns in Ethiopia. Anemia
Conclusion p. 1-6.
Maternal anemia has a significant effect on nutritional status 13. Subramanian SV, Ackerson LK, Smith GD, John NA (2009) Association
of children leading to stunting and underweight. Staying well- of Maternal Height With Child Mortality, Anthropometric Failure, and
nourished during this period of enormous growth as well as Anemia in India. JAMA. American Medical Association 301(16): 1691-
vulnerability can pave the way for a strong, healthy, productive 1701.
future. It is imperative to improve general health and hemoglobin 14. (2011) Haemoglobin concentrations for the diagnosis of anaemia and
assessment of severity. Vitamin and Mineral Nutrition Information
level of the women at child-bearing age, to protect children from System. Geneva, World Health Organization, WHO, USA.
being growth retarded. 15. Mushtaq MU, Gull S, Mushtaq K, Abdullah HM, Khurshid U, et al. (2012)
References Height, weight and BMI percentiles and nutritional status relative to the
international growth references among Pakistani school-aged children.
1. World Wide prevelence of anaemia 1993-2005, Atlanta. BMC Pediatr 12(12).
2. Miller JL (2013) Iron deficiency anemia: a common and curable disease. 16. Rao S, Joshi S, Bhide P, Puranik B, Kanade A (2011) Social dimensions
Cold Spring HarbPerspect Med 3(7). related to anaemia among women of childbearing age from rural India.
3. Prevalence of anemia among pregnant women (%), The World Bank, Public Health Nutr 14(2): 365-372.
USA. 17. Nazir G, Naz S, Ali S, Aziz S, Malik SA, et al. (2011) Anaemia: the
neglected female health problem in developing countries. J Ayub Med
4. Steven A, Finucane M, DeRegil L, Paciorek J, Flaxman SR, et al. (2015) Coll Abbottabad JAMC 23(2): 8-11.
Global, regional, and national trends in haemoglobin concentration 18. (2011) Government of Pakistan National Nutrition Survey, Pakistan.
and prevalence of total and severe anaemia in children and pregnant
and non-pregnant women for 1995-2011: a systematic analysis of 19. Arif GM, Farooq S, Nazir S, Sathi M (2014) Child Malnutrition and
population-representative data. Lancent Global Heal 1(1): 1-14. Poverty: The Case of Pakistan. ©The Pakistan Dev Rev 53(2): 99-118.
5. Abbaspour N, Hurrell R, Kelishadi R (2014) Review on iron and its 20. Singla PN, Tyagi M, Kumar A, Dash D, Shankar R (1997) Fetal growth in
importance for human health. Journal of Research in Medical Sciences maternal anaemia. Journal of tropical pediatrics (43): 89-92.
19: 164-174. 21. Ahmad MO, Kalsoom U, Sughra U, Hadi U (2011) Effect of Maternal
6. Alquaiz AM, Gad Mohamed A, Khoja T a M, Alsharif A, Shaikh SA, et al. Anaemia on Birth Weight. J Ayub Med coll Abbottabad 23: 77-79.
(2013) Prevalence of anemia and associated factors in child bearing age 22. Thuita FM, Mwadime RKN, Wangombe JK (2005) Child nutritional status
women in riyadh, saudiarabia. J Nutr Metab p. 1-7. and maternal factors in an urban slum in Nairobi, Kenya. East Afr Med J
7. ElShazley MK, Ibrahim AG, Masoud GM (1996) Risk factors of anemia 82(4): 209-215.
among women in the child bearing period and preschool children in 23. Senbanjo IO, Olayiwola IO, Afolabi WA, Senbanjo OC (2013) Maternal
Alexandria. J Egypt Public Health Assoc 71(3-4): 229-241. and child under-nutrition in rural and urban communities of Lagos
8. Nair M, Choudhury MK, Choudhury SS, Kakoty SD, Sarma UC, et al. (2016) state, Nigeria: the relationship and risk factors. BMC Res Notes 6:1.
Association between maternal anaemia and pregnancy outcomes: a 24. Addo OY, Stein AD, Fall CH, Gigante DP, Guntupalli AM, et al. (2013)
cohort study in Assam, India, p. 1-10. Maternal height and child growth patterns. Vol. 163, Journal of Pediatrics
9. Raza N, Sarwar I, Munazza B, Ayub M, Suleman M (2011) Assessment of 163(2): 549-554.
iron deficiency in pregnant women by determining iron status. J Ayub 25. Yucel O, Dede Cinar N, Dede Çýnar N, Nursan Dede, Cinar C (2009)
Med Coll Abbottabad 23(2). Maternal risk factors affecting newborn parameters. Pak J Med Sci Pak J
10. Anemia in pregnancy, GLOWM, UK. Med SciPart-II) Pak J Med Sci 2525(33): 386-390.
This work is licensed under Creative
Commons Attribution 4.0 License Assets of Publishing with us
Submission Link: https://biomedres.us/submit-manuscript.php • Global archiving of articles
• Immediate, unrestricted online access
• Rigorous Peer Review Process
• Authors Retain Copyrights
• Unique DOI for all articles
https://biomedres.us/
Biomedical Journal of 4522
Scientific & Technical Research (BJSTR)
no reviews yet
Please Login to review.
